Why is mock care not a good proxy for predicting hand contamination during patient care?

Background

Healthcare worker behaviours, such as the sequence of their contacts with surfaces and hand hygiene moments are important for understanding disease transmission.

Aim

The study objective was to propose a method for recording sequences of HCW behaviours during mock vs. actual procedures and to evaluate differences for use in infection risk modelling and staff training.

Methods

Procedures for three types of care were observed under mock and actual settings: IV-drip care, observational care, and doctors’ rounds on a respiratory ward in a university teaching hospital. Contacts and hand hygiene behaviours were recorded in real-time using either a handheld tablet or video cameras.

Findings

Actual patient care demonstrated 70% more surface contacts. It was also 2.4 minutes longer but equal in terms of patient contacts. On average, doctors spent 7.5mins (2.5mins for mock) with patients whilst auxiliary nurses took 4.9mins for “obs” (2.4mins for mock). While registered nurses took 3.2mins for mock IV-care and 3.8mins for actual observation this translated to a 44% increase in contacts. In 51% of actual care and 37% of mock care episodes, hand hygiene was performed before patient contact; in comparison, 15% of staff delivering actual care performed hand hygiene after patient contact on leaving the room vs 22% for mock care. Number of overall touches in the patient room was a modest predictor of hand hygiene. Using a model to predict contamination on hands from surface contacts for Staphylococcus aureus, Escherichia coli and norovirus, mock care underestimated microorganisms on hands by about 30%.